Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Article

Oral Lecture vs. seminar plus outpatient clerkship: What is the difference in the performance of medical students who were exposed to a new or an old family medicine curriculum as determined by their clinical competence and outcomes on final exams?

Outline

This study compared the relative effectiveness of a new curriculum in family medicine at the Technical University of Munich as compared with the traditional curriculum. The major outcomes for students in both curricula were the differences of results in end-of-semester exams as related to the development of a specific competency in solving problems with uncertain diagnosis (1. to recognize the difference between symptom and diagnosis; 2. to rule out possible dangerous diseases).

The curriculum was changed from a twenty-four hour oral lecture course for students at the beginning of the fifth year to a four hour seminar followed by one week clerkship in a family practice for students in the second half of their fourth year of a six-year medical course. The learning objectives were the same in both groups. These objectives were communicated to the lecturers and clerkship practitioners involved in both curricula. Relative effectiveness of the curricula was assessed at the end of the semester using a written course exam and questions with case studies dealing with uncertainty.

The mean score for both student groups for the exam that contained 51 multiple choice and mini essay questions was 30,82 points or 61%. The students exposed to the old curriculum had a statistically significant higher score (32,77 points; 65%) when compared with the students exposed to the new curriculum (29,14 points; 57%) (p< 0,01). In addition, the results of the student group with the old curriculum were slightly better (62,03%) than the new curriculum group (59,63%) in answering the specific case study questions about dealing with uncertain diagnosis.. The discrimination factor of this specific instrument was acceptable (r = 0,066).

These results show that students in the old curriculum performed better than students taught with the new curriculum. However the performance of the two student groups was less different in the part of the evaluation that used specific case study questions as compared to the overall assessment results of the two groups. This outcome could be explained by maturation in clinical decision making between fourth (new curriculum) and fifth year (old curriculum) students. The written course exam including a written essay test to measure the competency of medical students to recognize the difference between symptoms and diagnosis and to rule out possible dangerous diseases may be sufficient by itself as an assessment instrument.